Objective: To evaluate the efficacy of intravenous (i.v.) thrombolytic therapy on acute myocardial infarction (AMI) and to evaluate the sensitivity and specificity of clinical criteria in deciding reperfusion rate by using 90 minutes angiography after initiation of the i.v. urokinase (UK).
Methods: Coronary artery angiography (CAG) was performed in 124 out of 1406 patients with AMI receiving i.v. UK (UKTP) (Guangdong Techpool Biochemical Pharmaceutical Co. Ltd. Guangzhou, China) from November 1994 to April 1996. 1.5 million units of UKTP were infused in 111 patients, 2.0 million units in 10 patients and 1.0 million in 3 cases within 30 minutes. CAG was performed 90 minutes after the initiation of thrombolytic therapy.
Results: Fifty-two patients had coronary flow grade of TI-MI-3 and 38 patients TIMI-2 90 minutes after the onset of thrombolytic therapy. The total patency rate of infarct related artery (IRA) was 72.6%. There was no significant difference (P > 0.05) in the patency rate of IRA of various locations. The patency rate of LAD was 71.6% (53/74), of RCA was 71.4% (30/42), of LCX was 85.7% (6/7) and effective patency in one patient with left main artery occlusion. Although there was a tendency that the earlier the thrombolytic therapy, the higher the patency rate of IRA patency, the results did not meet the statistically significant level (P > 0.05). Using CAG as the gold standard, the clinical criteria used for evaluation of reperfusion rate had a sensitivity of 88%, specificity of 69% and accuracy of 83% in prediction of the reperfusion of IRA.
Conclusion: UK is effective and reliable in i.v. thrombolytic therapy of AMI. The clinical criteria used to predict reperfusion of IRA have a higher sensitivity and relatively lower specificity.